%0 Journal Article
%@ 0009-7322
%A Mahaffey, KW
%A Jardine, M
%A Bompoint, S
%A Cannon, C
%A Bruce, N
%A Herspink, LHJ
%A Charytan, D
%A Edwards, R
%A Bull, S
%A Capuano, G
%A De Zeeuw, D
%A Levin, A
%A Pollock, C
%A Wheeler, DC
%A Yavin, Y
%A Zinman, B
%A Rosenthal, N
%A Brenner, BM
%A Perkovic, V
%D 2019
%F discovery:10076979
%I American Heart Association
%J Circulation
%K canagliflozin, primary prevention, secondary prevention, cardiovascular outcomes, clinical trial, diabetes mellitus, chronic kidney disease
%N 9
%P 739-750
%T Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups: Results From the Randomized CREDENCE Trial
%U https://discovery.ucl.ac.uk/id/eprint/10076979/
%V 140
%X Background  Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without prior cardiovascular disease (primary prevention).  Methods  In CREDENCE, 4401 participants with type 2 diabetes and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care.   Results  Primary prevention participants (N=2181; 49.6%) were younger (61 vs 65 years), more often female (37% vs 31%), and had shorter diabetes duration (15 vs 16 years) compared to secondary prevention participants (N=2220; 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80; 95% confidence interval [CI] 0.67–0.95; P=0.01), with consistent reductions in both the primary (HR, 0.68; 95% CI, 0.49–0.94) and secondary (HR, 0.85; 95% CI, 0.69–1.06) prevention groups (P-interaction 0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78; 95% CI, 0.61–1.00), nonfatal myocardial infarction (HR, 0.81; 95% CI, 0.59–1.10), and nonfatal stroke (HR, 0.80; 95% CI, 0.56–1.15). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P-interaction >0.5 for each outcome).  Conclusions  Canagliflozin significantly reduced major cardiovascular events, as well as kidney failure, in patients with type 2 diabetes and chronic kidney disease, including in participants who did not have prior cardiovascular disease.
%Z © 2019 The Authors. Circulation is  published on behalf of the American  Heart Association, Inc., by Wolters  Kluwer Health, Inc. This is an open  access article under the terms of  the Creative Commons Attribution  Non-Commercial-NoDerivs License,  which permits use, distribution, and  reproduction in any medium, provided  that the original work is properly cited,  the use is noncommercial, and no  modifications or adaptations are made